Meatotomy

Definition

Meatus = the hole at the end of
the urethra through which one urinates

Otomy = to make a hole or opening
in

A meatotomy is performed for a condition referred
to as meatal stenosis (tightening or narrowing). Although
rare cases are discovered at the time of a circumcision
or in an uncircumcised male, the vast majority present
months or longer after circumcision. It is thought that
the meatus, no longer covered by foreskin, is now exposed
to irritation against a urine-soaked diaper, and consequently
scars. Parents will notice that their baby's urine shoots
upward, or that it uncontrollably sprays in multiple
directions. There is no effective medical treatment and
so a procedure is needed to correct the condition.

Meatotomy is performed as an ambulatory procedure,
usually under general anesthesia so that your child is
not aware of the procedure. Some surgeons will also
use a local injection of along-acting local anesthetic
agent to minimize pain upon when the child awakens.
This is rarely necessary, however. The recovery time
is typically very short. This procedure can sometimes
be done in the office with just local anesthesia.

Preparation

As with any procedure in which anesthesia is administered,
you will be asked not to feed your child anything (including
any liquids) after midnight on the evening prior to
the surgery. If your child is on medications that must
be taken, you will have discussed this with us and/or
the anesthesiologist and instructions will have been
given to you. If safely avoidable, the procedure should
no be performed if you child is on, or has recently
been taking any medication that may interfere with his
ability to clot his blood. This may not be of great concern
for this procedure, however. The most common of these
medications are aspirin-like compounds and all related
pain relievers, fever reducers, or anti-inflammatory
compounds(whether prescription or over-the-counter).
Please refer to the attached list and tell us if he
has taken any of these within the past 10 days. If his
medication is not on the list, alert us immediately
so that we may ensure optimal procedure safety. We will
have reviewed any of the current medications with you
during the pre-operative/pre-procedure consultation.
You are obligated to inform us if anything has changed
(medication or otherwise) since your previous visit.

Procedure

To review the basics of what we discussed in the
office: The procedure can take anywhere from 15-30 minutes.
The tiny bit of skin that is partially covering the
meatus is clamped (to interfere with blood supply) and
then simply cut. We then look at the size of the opening
to determine if it is large enough. In many instances,
one or two very small sutures are placed on either side
to help prevent a recurrence.

Sometimes a suture is needed to stop a small blood
vessel from bleeding. In other instances, no sutures
are placed. Sometimes an antibiotic ointment is then
placed on the newly opened meatus. No dressings are necessary.

Post Procedure

When done in the hospital, your child will be in
the recovery room for a short time before being sent
home. He may have some discomfort, but typically not
any severe pain. It is not uncommon to see small drops
of blood drip from the area. Try to keep the surgical
area dry for 24 hours. If your child is older (walking/running
age), we ask that he refrain from any strenuous activity
or rough play for two days. Some patients have almost
no discomfort while others are somewhat uncomfortable
for one to two days; longer is rare. Your child may
cry the first few times he urinates. He may have a stinging
or burning sensation from the urine hitting the recently
cut tissue. For discomfort, he may have any pediatric-dose over-the-counter
medicine to which he is not allergic (Tylenol®, Advil®
or other ibuprofen product). Upon follow up in the office,
we will examine the hole to ensure that it stayed open. The
sutures (if any were placed) are self-dissolving, and
do not require removal. In the first two to three days,
you may be asked to spread antibiotic ointment (i.e.
Bacitracin®) on the area to prevent the sutures or skin
from sticking to diapers or undergarments. The ointment
may also help to prevent recurrence. Some surgeons may
ask you to put your son into a warm bath a couple of
times a day. Some may ask you to gently spread the hole
apart a few times a day for the first few days to help
prevent the edges from sticking together.

Expectations of Outcome

You should notice that your child's urine stream
is no longer spraying or deflected upward. Again , he
may have discomfort the first few times that he urinates.
Encourage him not to hold the urine back. Sometimes,
placing him into a warm tub to urinate will be helpful.

Most meatotomies do stay open. There is a small chance
that the opening can scar down and need to be re-opened.
We often make the meatus wider than is necessary for
a successful outcome because we know and expect that
a small length of the cut tissue will scar closed. There
may be some swelling that may make the penis appear
curved or wide. This swelling will disappear over the
next one to two weeks.

The sutures (if placed) will break and fall out on
their own in one to three weeks. If a suture breaks early
(that day or within a couple of days), you need not
be concerned. Chances are it has already served its purpose.

Possible Complications of the Procedure ALL surgical
procedures, regardless of complexity or time, can be
associated with unforeseen problems. They may be immediate
or even quite delayed in presentation. While we have discussed
these and possibly others in your consultation, we would
like you to have a list so that you may generate questions
if you are still concerned. Aside from anesthesia complications,
it is important that parents be made aware of all possible
outcomes which may include, but are not limited to:

Recurrent Meatal Stenosis: Again, despite a
wide open meatus, some will re-close and perhaps
require another procedure.

Infection: Infection is quite unusual following
meatotomy, but is possible in any procedure. Usually,
local wound care and antibiotics are sufficient.

Penile or Urethral Injury

We provide this literature for patients and family
members. It is intended to be an educational supplement
that highlights some of the important points of what
we have previously discussed in the office. Alternative
treatments, the purpose of the procedure/surgery, and
the points in this handout have been covered in our face-to-face
consultation(s).

The information contained in this document is intended
solely to inform and educate and should not be used
as a substitute for medical evaluation, advice, diagnosis
or treatment by a physician or other healthcare professional.
While Delta Medix endeavors to ensure the reliability
of information, such information is subject to change
as new health information becomes available. Delta Medix
cannot and does not guaranty the accuracy or completeness
of the information contained in this document, and assumes
no liability for its content or for any errors or omissions.
Please call your doctor if you have any questions.